Point-of-care ultrasound in geriatrics: a national survey of VA medical centers

Maya Gogtay, South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA. drgogtay@gmail.com.
Ryan S. Choudhury, South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA.
Jason P. Williams, Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA.
Michael J. Mader, South Texas Veterans Health Care System, Research Service, San Antonio, TX, USA.
Kevin J. Murray, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
Elizabeth K. Haro, Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.
Brandy Drum, Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
Edward O'Brien, Health Analysis and Information Group, Department of Veterans Affairs, Milwaukee, WI, USA.
Rahul Khosla, Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington, DC, USA.
Jeremy S. Boyd, Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA.
Brain Bales, Department of Emergency Medicine, VA Tennessee Valley Healthcare System-Nashville, Nashville, TN, USA.
Erin Wetherbee, Pulmonary Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
Harald Sauthoff, Medicine Service, VA NY Harbor Healthcare System, New York, USA.
Christopher K. Schott, Critical Care Service, VA Pittsburgh Health Care Systems, Pittsburgh, PA, USA.
Zahir Basrai, Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Dana Resop, Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA.
Brian P. Lucas, Medicine Service, White River Junction VA Medical Center, White River Junction, VT, USA.
Sandra Sanchez-Reilly, South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA.
Sara Espinosa, South Texas Veterans Health Care System, Department of Geriatrics, Gerontology and Palliative Medicine, San Antonio, TX, USA.
Nilam J. Soni, Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.
Robert Nathanson, Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.

Document Type

Journal Article

Publication Date

9-27-2023

Journal

BMC geriatrics

Volume

23

Issue

1

DOI

10.1186/s12877-023-04313-2

Keywords

Geriatricians; Point-of-care ultrasound; Veterans administration

Abstract

BACKGROUND: Point-of-care ultrasound (POCUS) can aid geriatricians in caring for complex, older patients. Currently, there is limited literature on POCUS use by geriatricians. We conducted a national survey to assess current POCUS use, training desired, and barriers among Geriatrics and Extended Care ("geriatric") clinics at Veterans Affairs Medical Centers (VAMCs). METHODS: We conducted a prospective observational study of all VAMCs between August 2019 and March 2020 using a web-based survey sent to all VAMC Chiefs of Staff and Chiefs of geriatric clinics. RESULTS: All Chiefs of Staff (n=130) completed the survey (100% response rate). Chiefs of geriatric clinics ("chiefs") at 76 VAMCs were surveyed and 52 completed the survey (68% response rate). Geriatric clinics were located throughout the United States, mostly at high-complexity, urban VAMCs. Only 15% of chiefs responded that there was some POCUS usage in their geriatric clinic, but more than 60% of chiefs would support the implementation of POCUS use. The most common POCUS applications used in geriatric clinics were the evaluation of the bladder and urinary obstruction. Barriers to POCUS use included a lack of trained providers (56%), ultrasound equipment (50%), and funding for training (35%). Additionally, chiefs reported time utilization, clinical indications, and low patient census as barriers. CONCLUSIONS: POCUS has several potential applications for clinicians caring for geriatric patients. Though only 15% of geriatric clinics at VAMCs currently use POCUS, most geriatric chiefs would support implementing POCUS use as a diagnostic tool. The greatest barriers to POCUS implementation in geriatric clinics were a lack of training and ultrasound equipment. Addressing these barriers systematically can facilitate implementation of POCUS use into practice and permit assessment of the impact of POCUS on geriatric care in the future.

Department

Medicine

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